As one component of the academic enterprise, state-university collaborations have had a longstanding role in resident training and, albeit to a somewhat lesser extent, in other facets of missions among academic departments of psychiatry. In an original 1980 survey of 115 chairs of departments of psychiatry in which 98 chairs responded (85%) to a mailed questionnaire (1), 71% of respondents indicated that they had an ongoing relationship with a state hospital. Sixty percent said that they used the hospital as a training site for their residents. Overwhelmingly (cited by 95% of respondents), the state hospital was considered to be a valuable and quality educational experience for residents. When an identical survey was repeated in 1990 (2), the same impressions were upheld. Among respondents (82 of 110 chairs for a 75% response rate), chairs still considered this an important component of their academic enterprise with 79% (n=46) indicating that they had a training relationship for their residents involving the state hospital. On a 5-point scale evaluating the quality of the relationship (1=unsatisfactory-uncooperative, 5=excellent), 69% of chairs rated the relationship as cohesive and collaborative (4 points or better). State hospital rotations provide access to complex patient presentations, experience in forensic circumstances, opportunities for developing specialist skills in psychopharmacology, and learning about public psychiatry. The promise and pitfalls of these resident experiences, as well as the broader context of state-university collaborations in mental health, have been the subject of many informative publications over the years (3–12). These articles detail the excellent training opportunities, broad research opportunities, and professional experience of working in a health care sector in which the focus is generally different from that of most academic departments of psychiatry.

Over the 25 years since the original evaluation by Faulkner et al. (1), many influences both within academia and the public mental health system may have influenced this relationship (Table 1). On one hand, academic medical centers now operate under intense financial strain (13), and perhaps academic departments of psychiatry have sought some relief from this in drawing closer ties with the state hospital system. On the other hand, we know from experience and from the President’s New Freedom Commission (14) that the public mental health system is already overburdened. Perhaps state systems let their university affiliations lapse to conserve scarce financial resources. To this end, we were interested to determine whether there had been any significant changes in either the extent or quality of state-university collaborations since 1980. Accordingly, we resurveyed academic department of psychiatry based upon the original survey.

In January 2005, a survey and copy of the prior work was sent to the chairs of 119 U.S. academic departments of psychiatry with accredited psychiatric residency training programs. This survey is available from the authors upon request. It comprised 25 items, as either yes/no questions, items rated on the 1–5 scale, or brief, unstructured/open answers. Twenty questions were identical to the original survey. The five additional questions focused on whether relationships had changed substantially over time and gave respondents an opportunity to add further comments. Copies of the prior publications (1, 2) were also included to enhance interest and participation in the survey. In addition to mailing letters of request, several e-mail follow-up correspondences were made to those who had not responded. No statistical analyses were performed on aggregated data. Percent responses among each question were collated (naturally, there was variability in response across questions). These were compared with corresponding rates for the prior two surveys.

Of the 119 chairs of departments of psychiatry, 58 (49%) responded. Seventy-five percent of respondents (n=46) reported some administrative relationships with state hospitals. Seventy-two percent (n=42) reported that state hospitals were used as training sites for residents. In evaluating their relationship with the state hospital on the 5-point scale used in the prior survey, 64% of respondents gave a rating of 4 or above. This is indistinguishable from the corresponding figure of 69% respondents in the original survey.

In positioning the state hospital resident experience within overall training program activities, the state hospital rotation was reported as required in 74% of departments and as an elective opportunity in 48% of departments. The perceived importance of the rotation—of major importance (cited by 52% of respondents to this question, n=20) or of minor importance (48%)—did not differ materially between 1980 and 2005. Forty-six percent of respondents to that question (n=21) indicated that their departments were receiving resident stipends. This was broadly similar in percent to 1980, although the average number of hours of resident service was more substantial (at 28 hours per week). Salary support is an important aspect of this relationship for academic departments. Although noting the presence of these arrangements, the survey did not determine any other meaningful information regarding contractual arrangements, for example.

Travel distance between the state hospital and the department of psychiatry remains the major disadvantage of this training site, as indicated by 36% of respondents. The two main advantages were the same across time: exposure to this patient population (cited by 83% of respondents to that question [n=35] in 2005, 96% of respondents [n=51] in 1980) and the overall exposure to public psychiatry (cited by 36% of respondents [n=15] in 2005 and 41% [n=22] in 1980). The importance of exposure for forensic training was specifically cited by 17% of respondents to that question (n=7). However, an important limitation of our methodology is that the survey does not provide specific details of rotations or forensics, and/or place these activities in the context of whatever else residents are doing.

State-university collaborations can offer many advantages to both organizations (12). Although the low response rate is noteworthy and an important caveat in interpreting survey results, the impression here is that state-university collaborations remain an important component of an academic department’s residency training program. This impression is endorsed by the high ratings of the quality of this relationship, a measure that was consistent across both surveys 25 years apart. Additionally, although it is likely that departments’ access to an array of sites for training of residents has increased—diversified over the last 25 years—the state hospital remains an important training site. Seventy-four percent of respondents indicated that their residents spent time in training at the state hospital. In most instances, this was on formal rotations. The state hospital was still a source for resident stipend support.

Resident training at the state hospital continues to be an important learning experience, with the opportunity for forensic experience being cited as valuable among respondents. The longer length of stay at state facilities provides residents with more opportunity to observe and learn from the impact of their therapeutic interventions. However, distance traveled and time away from the department continues to be a significant detractor to the resident experience.

It is unclear why the response rate among chairs was substantially lower than in the two previous surveys and explanations are speculative. Perhaps some chairs have become disenchanted with these relationships and chose not to respond or the longer extent of this questionnaire disadvantaged this survey so that chairs did not complete it. Nevertheless, the findings suggest that strong state-university collaborations have been sustained over the past 25 years despite major changes in the academic health care and training environment during this period.

At the time of submission, the authors reported no competing interests.